Prediabetes can become actual diabetes

Sunday

Aug 30, 2009 at 12:01 AM

DEAR DR. DONOHUE: Recently you wrote that for prediabetes, one should lose weight and exercise. I have prediabetes, but I am a fitness instructor who works out nearly every day. I weigh 113 pounds, and people tell me I am too thin. It is always assumed that people with this problem are overweight. I have taken diabetes classes, but my diet doesn't help me. I eat well. Any help?

Paul G. Donohue M.D.

DEAR DR. DONOHUE: Recently you wrote that for prediabetes, one should lose weight and exercise. I have prediabetes, but I am a fitness instructor who works out nearly every day. I weigh 113 pounds, and people tell me I am too thin. It is always assumed that people with this problem are overweight. I have taken diabetes classes, but my diet doesn't help me. I eat well. Any help?

— G.G.

A normal fasting blood sugar (plasma glucose) is less than 100 mg/dL (5.6 mmol/L). A reading of 126 (7.0) or higher indicates diabetes. Values between those numbers put people in a class called prediabetes. These people don't have diabetes, but a significant number of them progress to diabetes in three to five years. Most of these people are overweight and inactive. G.G. is not one of those. She's an exception to the rule, and I can appreciate how it grates on her to be told to lose weight and become more active. For those who are overweight, such recommendations are an excellent way to get out of the prediabetes category.

G.G., you're doing everything right. You might make a few dietary changes that could make a bit of a difference in your fasting blood sugar. Eat more fiber. Limit foods with a high glycemic index. The glycemic index indicates how quickly a food breaks down to sugar and how rapidly it raises blood sugar. Potatoes, white bread and white rice are foods with a high glycemic index. Cut down on these foods.

The only other thing that could be considered for someone like you is to start an oral diabetes medicine. Not all experts favor such an approach. Another approach is to have your fasting sugars checked from time to time and take medicine only if they are in diabetes territory. You are an exception to the usual person who develops type 2 diabetes. You might never progress to that stage.

DEAR DR. DONOHUE: I am 52, am currently experiencing menopause and am considering taking hormones. What is your opinion of bioidentical hormones? They have gotten lots of publicity. Does it really take a hormone specialist to do the blood work involved in their use? Can my regular OB/GYN doctor do it? I understand that the hormones must be purchased from special dispensing outlets and do not seem to be covered by insurance. I have a friend who takes bioidenticals, and she swears she sees a difference. She paid $600 for blood work and pays more than $100 a month for the hormones. I am not averse to taking regular hormones if they ease my symptoms, but I want to weigh all my options.

— S.C.

"Bioidentical" was coined to describe a hormone with the exact molecular structure that the hormone made by a woman's ovary has. Is this an advantage? Those promoting the use of bioidenticals say it is. They say they can prescribe a customized hormone made for a woman's particular hormone profile as measured by lab tests.

As you say, bioidenticals have garnered lots of press coverage. Not all doctors are sold on their value. The process is costly. The Food and Drug Administration says there isn't any evidence that bioidentical hormones are safer or more effective than other hormone products, the products that have been used for many years and are less expensive.

If I had to make the decision for myself, I'd stick with my OB/GYN doctor, and I would use hormones that have been prescribed for so many years with such good results.

DEAR DR. DONOHUE: Please don't consider this a crazy question. I have always wondered why people who are on the ocean in a boat without any supplies cannot drink ocean water. I know it has salt in it, but much of what we eat has salt in it.

— K.D.

Ocean water has lots of salt in it. Humans have to get rid of a certain amount of salt daily. They get rid of it by flushing it out. It takes about a quart of water to achieve that. If a person were to drink a quart of salt water, he would need an additional quart or two of plain water get rid of the salt in the sea water. He would be no further ahead by taking in salt water. He might actually be behind some.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.